OBJECTIVES: As our institutions engage in new online learning and community spaces, the roles of the medical librarian have shifted to encompass these new environments. In Second Life (SL) and other virtual worlds, while the fundamental goals of service, support, collection development, reference, and outreach remain the same, the scope of audience and delivery of health information in support of these goals takes on a vastly different form. METHODS: An academic medical library collaborated with local health sciences schools and programs on developing a SL space. The librarians initiated training sessions on SL skills; organized a seminar series; developed resources and exhibits that bridged the virtual world and online environments; collaborated with local, national and international partners; and broadly served as community managers for the Second Life community and space.RESULTS: Outcomes of the librarians' activities as community managers included professional presentations in SL, creation of tools to index health information in SL, engagement with patient support communities, and formation of an international SL health education community. CONCLUSIONS: Second Life offers exceptional opportunities for health and medical librarians through flexible and innovative new roles.